Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | F350168-1 | NY |
NPI | 1073521464 |
---|---|
Provider Name | Ms. Siobhan Cassidy |
First Address | Stony Brook, NY 11790 |
Second Address | Stony Brook, NY 11794-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2006 |
Last Update Date | 04/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01974749 | (05) | NY |